11.13.2024 Recrods Destruction Certificate
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ARIZONA STATE LIBRARY, ARCHIVES AND PUBLIC RECORDS A DIVISION OF THE ARIZONA SECRETARY OF STATE CERTIFICATE OF RECORDS DESTRUCTION ARCHIVES AND RECORDS MANAGEMENT 1901 West Madison Street • Phoenix, Arizona 85009 (602) 926-3720 • records@azlibrary.gov • http://www.azlibrary.gov/arm Revised 07/03/2024 As authorized under ARS §41-151.19, "...A report of records destruction that includes a list of all records disposed of shall be filed at least annually with the state library on a form prescribed by the state library." Failure to comply with these procedures is a violation of ARS §41-151.19. INSTRUCTIONS Use this form ONLY for records that were destroyed and were on a current approved Retention Schedule 1. In the top section enter the name of your Agency or Public Body, and include any subdivision breakdown for division, department or unit. 2. List the Record Series associated with the destruction using the exact record series number(s) and name(s) found in the Retention Schedule Database. 3. Enter the earliest date of records you are requesting to destroy under the Records Start Date column and the latest date for the records you are requesting to destroy under the Records End Date column. 4. Enter the date the records were eligible for destruction. 5. Enter the format of the records to be destroyed under the Format: Paper, Digital, Microfilm column. 6. Enter the number of records being destroyed under the Number of Files, Boxes, Reels or Electronic File Size column. 7. If additional pages are needed for reporting, please attach a file with the certificate when sending to the Arizona State Library, Archives, and Public Records. 8. At the bottom of the form the Agency or Public Body Records Officer must sign and date the Certificate of Destruction to certify the records were properly destroyed. 9. Send the completed form and any additional files to records@azlibrary.gov or records@azsos.libanswers.com. ARIZONA STATE LIBRARY, ARCHIVES AND PUBLIC RECORDS A DIVISION OF THE ARIZONA SECRETARY OF STATE CERTIFICATE OF RECORDS DESTRUCTION ARCHIVES AND RECORDS MANAGEMENT 1901 West Madison Street • Phoenix, Arizona 85009 (602) 926-3720 • records@azlibrary.gov • http://www.azlibrary.gov/arm Revised 07/03/2024 CERTIFICATE OF RECORDS DESTRUCTION A.R.S. §41-151.19. Those records determined to be of no legal, administrative, historical, or other value shall be disposed of by such a method as the state library may specify. A report of records destruction that includes a list of all records disposed of shall be filed at least annually with the state library on a form prescribed by the state library. Public Body _________________________ Division _________________________ Department _________________________ Office/ Unit _________________________ Record Series Number and Title Records Start Date Records End Date Eligible to Destroy Date Format: Amount Paper Microfilm Digital Boxes Files File Size ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ ☐ Form Filled Out By (print): Email: Phone: Records Officer Name (print): Title (print): Date: Records Officer Signature: Email: Phone: City of El Mirage City Clerk City Clerk WIFA FY07 Grant 10279 1.20.2007 6.30.2007 6.30.2010 x 1 WIFA FY09 Grant 10279 3.12.2009 6.30.2009 6.30.2012 x 1 WIFA FY12 Grant 10279 1.20.2011 6.30.2011 6.30.2014 x 1 CDBG Home Grants FY10-15 20652 7.1.2009 6.30.2015 6.30.2020 x 1 CDBG Home Monitoring 20652 5.4.2010 6.30.2011 6.30.2016 x 1 CDBG Primrose 20652 8.31.2007 6.30.2008 6.30.2011 x 1 CDBG Pueblo 20652 10.11.2012 6.30.2013 6.30.2016 x 1 HUD Grant FY11 10279 8.9.2010 6.30.2011 6.30.2013 x 1 Sharon Antes santes@elmirageaz.gov 623.876.2943 Sharon Antes City Clerk 11.13.2024 santes@elmirageaz.gov 623.876.2943